Botox Aftercare: What Not to Do in the First 24 Hours
Most botox questions come after the appointment, not before. Can you exercise? Lie down? Drink wine at dinner? Wash your face? This guide answers everything — with the reasoning behind each instruction, not just the rules.
The treatment ends when the doctor cleans the injected areas. But what happens in the hours that follow still matters — and can make the difference between an optimal result and one that falls short. This guide covers botox aftercare based on the clinical protocols used at Cosmo Clinic.
Before running through the list, here is why aftercare exists. Botulinum toxin is injected directly into a target muscle. In the first few hours, it is binding to local nerve endings. Any factor that increases blood flow, creates mechanical pressure on the area, or raises body temperature can disperse the product into unintended muscles — with consequences that may include asymmetry, eyebrow ptosis, or insufficient effect.
What NOT to do: the complete list
No exercise for the first 24 hours
Exercise raises heart rate and body temperature, increasing blood flow to the treated area. This can move the toxin to adjacent muscles before it fully binds. Wait at least 24 hours — and 48 hours for high-intensity training.
Do not lie down in the first 4 hours
Lying flat or tilting your head significantly forward can displace the toxin before it binds. Stay upright for the first 4 hours after treatment. After that, sleeping position is unrestricted.
Do not touch, massage or rub the treated area
Direct mechanical pressure on the injected zones can shift the product. Avoid touching the treated areas, rubbing your face with a towel, or using circular motions when cleansing during the first few hours.
No alcohol for the first 24 hours
Alcohol is a vasodilator — it increases blood flow and the risk of bruising at the injection site. A glass of wine at dinner on the day of treatment is not advisable. Wait until the following day.
Avoid intense heat for 48 hours
Sauna, steam room, very hot baths, hot showers and prolonged sun exposure should all be avoided for the first 48 hours. Heat can reduce the product's stability and increase local swelling.
No facial treatments for 2 weeks
Facial massage, chemical peels, microdermabrasion, laser, radiofrequency or any treatment involving pressure, heat or abrasion in the treated zone should wait 2 weeks. If you have multiple treatments planned, botox should be the last one in the sequence.
Wait before applying makeup over injection points
Allow at least 4 to 6 hours before applying makeup over the treated areas. Avoid pressing brushes or sponges directly onto the injection points during this initial window.
Avoid NSAIDs (ibuprofen, aspirin) unless medically necessary
Non-steroidal anti-inflammatories increase bruising risk. If you need a painkiller on the day of treatment, paracetamol is the preferred option. Ideally, suspend NSAIDs and supplements such as omega-3, vitamin E and ginkgo biloba for 48–72 hours before your appointment.
Clinical note
Most of these restrictions apply to the first 4 to 24 hours. After that window, your normal routine can be resumed gradually. Following these instructions is not excessive caution — it is what separates an optimal result from an average one.
What TO do after botox
Aftercare is not just a list of prohibitions. There are also things worth doing actively to protect and optimise your result:
- Stay well hydrated: drink water normally. Systemic hydration does not affect the toxin but supports overall skin health.
- Apply a gentle cold compress if there is swelling: a cool compress (not ice directly on skin) can help reduce mild swelling in the hours after treatment. Do not apply heat.
- Use SPF 30+ sunscreen when going outside: especially in the first 48 hours. The skin around the injection points may be slightly more sensitive.
- Continue your normal moisturising routine: your usual moisturiser and serum can be applied normally, as long as you are not actively massaging the treated areas.
- Make your normal facial expressions: a common myth is that moving your face displaces botox. It does not. Smiling, frowning (while you still can) and speaking are all fine.
- Attend your 2-week review appointment: this is when the final result is assessed and a touch-up is performed if needed — included in your treatment.
Related Treatments
Explore botox treatments at Cosmo Clinic
Forehead, crow's feet, glabella — each area has a specific protocol and technique.
View all treatmentsDay-by-day timeline: the first 7 days
Here is what to expect — and what the rules are — at each stage:
First 4 hours
Initial binding phase
Stay upright. Do not touch the treated areas. Avoid heavy makeup. No alcohol. Avoid high temperatures (hot car, direct sun). After 4 hours you may wash your face gently with lukewarm water.
Hours 4 to 24
Stabilisation
You can sleep in your normal position. You can wash your face and apply makeup with a gentle touch. Avoid exercise and alcohol. No sauna, steam room or prolonged sun exposure.
Days 2 to 4
First signs of effect
You may begin to notice a slight reduction in muscle movement in the treated areas. The result is not final yet — the toxin is still working. You can resume moderate exercise. Avoid sauna and chemical peels.
Days 5 to 10
Result developing
The effect builds progressively. It is normal for one area to look more relaxed than another at this stage — final symmetry is only assessable at 2 weeks. Normal exercise and all skincare can be fully resumed.
Day 14
Final result + review appointment
The result is fully established. Your review appointment takes place — the doctor assesses the effect, takes comparison photos, and performs a touch-up if needed (included in your treatment).
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The vast majority of treatments proceed without any issue. That said, there are signs worth reporting to your doctor:
- Upper eyelid drooping (ptosis): rare, but possible if the toxin migrates to the levator palpebrae muscle. It typically appears on days 2 to 5 and is reversible over time or with prescription eye drops.
- Marked asymmetry after 2 weeks: minor asymmetries in the first week are normal. Visible asymmetry once the result is established should be assessed — it can be corrected with a touch-up.
- Persistent local pain or swelling with signs of inflammation: uncommon, but worth a medical assessment. Small bruises are normal and resolve within days.
- Very insufficient effect after 2 weeks: in first-time treatments or with particularly strong muscles, the dose may need adjusting at the review appointment.
At Cosmo Clinic, the 2-week review is included in every treatment. It is the moment to raise these assessments with the doctor who carried out the procedure.
Frequently Asked Questions
Not in the first 24 hours. Exercise increases blood flow and body temperature, which can disperse the toxin. After 24 hours you can resume moderate activity. For high-intensity training, wait 48 hours.
Yes, but wait 4 hours after treatment. Use lukewarm water and a gentle touch — do not rub the treated zones. After that initial window, your normal cleansing routine can fully resume.
First signs typically appear on day 3 to 5. The full result develops over 10 to 14 days. The 2-week review appointment is scheduled at this point because it is only then that the final result can be properly assessed.
Avoid alcohol for the first 24 hours. It dilates blood vessels, increasing bruising risk and potentially affecting local product stability. After 24 hours, moderate consumption is fine.
Not in the first 4 hours. Keeping your head upright helps the toxin bind locally. After 4 hours you can lie down and sleep in your usual position with no restrictions.
Wait 4 to 6 hours before applying makeup over the treated zones. After that, your makeup routine can resume — just avoid pressing brushes hard directly onto injection points in the first day.